Abstract
Although group B Streptococcus (GBS) is a leading cause of severe invasive disease in young infants worldwide, epidemiologic data and knowledge about risk factors for the disease are lacking from low- to middle-income countries. To determine the epidemiology of invasive GBS disease among young infants in a setting with high maternal HIV infection, we conducted hospital-based surveillance during 2004-2008 in Soweto, South Africa. Overall GBS incidence was 2.72 cases/1,000 live births (1.50 and 1.22, respectively, among infants with early-onset disease [EOD] and late-onset [LOD] disease). Risk for EOD and LOD was higher for HIV-exposed than HIV-unexposed infants. GBS serotypes Ia and III accounted for 84.0% of cases, and 16.9% of infected infants died. We estimate that use of trivalent GBS vaccine (serotypes Ia, Ib, and III) could prevent 2,105 invasive GBS cases and 278 deaths annually among infants in South Africa; therefore, vaccination of all pregnant women in this country should be explored.
Highlights
Group B Streptococcus (GBS) is a leading cause of severe invasive disease in young infants worldwide, epidemiologic data and knowledge about risk factors for the disease are lacking from low- to middle-income countries
Progress has been made in the development of a trivalent GBS polysaccharide–protein conjugate vaccine (GBSCV), which is targeted for use in pregnant women; the goal is to enhance transplacental transfer of capsular antibody to the fetus [1,8,9,10], which could protect against early-onset disease (EOD) and late-onset disease (LOD)
Complete medical records were unavailable for 17 cases (10 EOD, 7 LOD), which were included in incidence calculations but not in univariable analysis
Summary
Group B Streptococcus (GBS) is a leading cause of severe invasive disease in young infants worldwide, epidemiologic data and knowledge about risk factors for the disease are lacking from low- to middle-income countries. Considerable intra- and interregional variation in the incidence of invasive early-onset disease (EOD; disease in 0- to 6-day-old infants ) was observed [3,4,5], ranging from 1.21 cases/1,000 live births (95% CI 0.5–1.91) in Africa to 0.02 cases/1,000 live births (95% CI 0–0.07) in Southeast Asia [3]. This variability is inconsistent with the lesser difference in prevalence of maternal GBS colonization, the major risk factor for EOD, in women from different regions (20.9% in Africa, 13.4% in Southeast Asia) [6]. Improved estimates of the incidence of invasive GBS disease are needed from low- and middle-income countries to contextualize the prioritization of GBS vaccination and determine whether temporal changes in invasive serotypes should be considered in the design of serotype-specific GBS vaccine
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